02050026CITY
DIIVISIONNO
BUILDING CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10383 TORRE AVE GEORGE G HANSEN CONSTRUCTI N 02050026
WNER'S NAME: APPLICATION SUB DATE
CUPERTINO DENTAL GROUP 303 OVERLOOK DR 05/06/2002
PHONE: SANITARYNO. CONTROL NO.
(831)338-2684
z ARCHITEC (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a
i LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby aRrm that l am licensed under pro inions of Chapter 9(commencing
w iN Sao, 70)0) n cion 3 Ofrhe Businesse Professions Code, and my license TENANT IMPROVEMENT
is in rce an t.
Lie Lim.
Date 'C
ContVAION
fn ARCHITECT'S D
�undersund my plansshall be used a ''
1•� iii
OLicensed Pmfusional
OWNER -BUILDER GLARATI
j�gW1'yA
H 1 hcmby affirm that 1 am exempt f 's L' for the
following reason. '•' aa�t.
(Semon ]031.5. Business CWe: r county
O which requires a permit to construct, or $60000
alter, improve, demolish, repair any stmcmrc ED
m ..prior m iu issuance, oho requires Ne applicant for sucb permit m file a sigsmd suumem
- sharhgislittnIt" ytvsWin"a ptwiuonsoftneConuacwlsLicenseLaw (Chspa" 9 Valuation
(commenGin;•iN A7 Of Division Sof the Businca and Profeaaions Code) +,",�'f�'i•317i?VVi
or thin rte is exempt thercfmm'ond The eters for the Wlcgbf,u'xemptiop. Any violation I
- of Seninm7031:5 by any npplicatn far o permit subjects the applicant to a civil penalty
of nut mina than. five hundred dollars(S5001. t`�""' Occupancy Type
101AP-NV ATION
❑ I, as owner of the property, or my employees with wages as their able compensation, _
-wilt do the work, sand -the structure is not Intended Of'Offered '(Or sale (See 704,1 " - - -
Business end Professions Code: The Contractor's License Law does not apply to an 103 - UFER Required Inspections' ^' '•-
owner of property Who builds or improves thereon, and who does such work himself
o through his own e pI y p idcd ibat i h improv m f not intended or 104 - RE BAR
-:'offercdfor le aimprovementu ld nne of " — •'' "-'
tl<ll he 105 ANCHOR BOLTS
owner of
completion, the weer -builder libuildinger W he
-ld have the Nen did not buil)
will pronng thin build or
improve for "oppose of.nm.). 106 - SEWER & WATER ' -.....
- _-----e ...---- ---- -- - - .._.. _._-._ .._ ....--.._. ---- „-.----
202--=
'71; as owner of the pmpeny.am exclusively contracting with licenud conuacton tO UNDERFLOOR PLUMBING : f.i'i �''ti'�I ti-••..
construct the project (Se<. 7044, Business and Professions Cad,:) The Contractors •.. .'
'- L' 1 d s not apply t an owner of property who b ' d improves thereon 203 - UNDERFLOOR MECHANICAL' �' `'
..and ho <o , acts.f r such projects with.a commctions) licensed.purs ant In me' - _, ..,. .
__2.04. — UNDERFLOOR-
C C f t L ccnab la - - „
1 t ode See- '' B&PCfor this Maabn 205 - UNDERFLOOR''"INSULATION
ro,=r $ O'Z- 301 - ROUGH PLUMBING
' WORKE COM ATIONDECLARATION
302 - TUB & OR SHOWER
he nr Miiarydnenfthefnnnwingdoelmamns: 303 - ROUGH MECHANICAL
❑ 1 have rural wdl'mainiam'a Cenifictte'of consem'm self -insure for worker's 3 04 - ROUGH ELECTRICAL
- Compensation,- u provided for by -Section 3700' of the Labor Code, for the
_ NrOnamee of foe work far which this Pgrmiti,issued . 305 — FRAME
❑Ihaveund'will martian Workers Compensations Insurance, as required by Section 306 - HOLDOWNS
3]IXI of the tabor Cad for The, Porro once (the work far which this Penna is -
issuedMy W fkei s Compcnsafion 1 r c and P l cy r rube m 307 INSULATION
_. _..r_..__
:.__...-•_._--_-._......�.•`-�
,:amer•3 ..� 308"=':SHEETROCK"....
Poj<
CERTIFICIAIROMWORK`�
sIATIONO El Ens d'i!i309�"-'�BRTERIOR%'tLATHi
'_ A TIO rt i
Q •._, • . • -3-10-, --" , • i---------------... - .... -....... ..
..•,-1N
SURANCBfnr
1' TERI OR""liATH •"
hunduJ-.
' T
(Tone seatlun need nut be'<um p lean if me a f one done
isiBB)uness.j '' 311 - SCRATCH COAT
, I dent Nei fn performance f rk f which th fs i s W I " -3.1 --- -ROOF NAIL--
„ y th i pertti t x
'shallnotemploy nyp n on m- sqy rmtheW kers 501 - FINAL EI;BCTRI' `'•ENERGY
nsxtgry Laws fC hf m' D
ant P%.g P��— 502.._ -..FINAL . PLUMBING ENERGY_.-- -- -
ICE AP L T If,
ANT: afmrmallsuglhnCemficmeofExemption: you should -
>- become iubPmtmthe Workers Compensation provisions of the Labor Code, you must 503 FINAL MECHANICAL"•'ENERGY
roanwimdomplywNrucnpmvisionaonhlsPermit xhWlbcdeemedmvuked.
j _ _ 504, FINAL BUILDING__..__.._____
CONSTRUCTION IENDINGAOENCY '., 505 - FINAL ELECTRICAL
I he by tftmt that there construction lending agency f the po formance 1
., bfth work f hich the picmt issued (Sac.309] Civ CI SO6 - GAS TEST ._.. .._. .__._..__
...Led Nnme '---- ._. .-.. .._.� _ _�. ..........
L ddrsAMlmssn 507 - FINAL PLUMBING,
> I certify that (pave rood this application end sum thin the above information is 508 - FINAL MECHANICAIli`
'coven. 1 agree with all ordinances sum laws relating'
nand 509 - FINAL GRADE
m racomply countywm
building conumaion :ted hereby hunk ri ze reprtsenmtives sof this city m enter upon
the sporla SIO — FINAL PLANNING
aboeWmentim16sve ardluoifymdionpuryoses.-
L (Wejsgreemmve, the idCa e
6
andepennd
G ks in 514 - FINAL UB C WORKS
cosh which wayacrusaid
end hihamay in any way accrue against said
may, against
inifmato
City
City canuqucnce of
in nerre of the of thispermit.
mg the
mg
y'AmpICANT UNDERSTAN" A WILL COMPLY WITH NON POINT'
'SOIIRCEREGULATIONS;'';"I''I'^l•'' i •. Issued by: Date
Sg t ApplicanUContnmm- '."'�. (Dam Re -roofs
• - -
: HAZARDOUS MATERIALS DISCLOSUR
!. worn appbcant 6 occupant tore or handle hazaNau�ftmrenal ,.Type Of Roof_ _.. ._.._._�.__......, .. _-.. ...
. m d f ed by N Cppcmnod Chepmr 9 12 a d the Health rW Sefery
Cade S t n255711e) e
° ^
,❑Yu
orBldrr"2
.All
roofs shallbeirispectedprlor.to any
roofing•materialbeinginstalled,•„th
occupant nne equpment Or device, whichIf a roof is installed'without first obtaining an'inspection,4agree to.remove
AutharnNous.1 camamby the Bay Arca Air O Wiry Management
Distnct all new materials for in_spechon _ Applican_ t understands and will comply, with _
0yes �N all non=point source [egulanons..
t
I have read the h rami ti msoroxis neutron a under Chapter 695 of the
Caldomiu Health &Surety Cade; Sections 25505:25533 and 25534; hundemand that .. _. ..__. ... _.. ....__._.. .. ..... _. - _..._
•if,ihe ng does not currently haveamnanr. thin it is my responsibility to notify the "" - '
;occupant of '
rhe it the requirements which'ntust he met prior hiissuance of,. Certs&am of
OR
Oil
r
y • . .
Signature of Applicant Date
All roof coverings to be Class `B ,or better
g Dae
CITY
DIIVISIONNO
BUILDING CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10383 TORRE AVE GEORGE G HANSEN CONSTRUCTI N 02050026
WNER'S NAME: APPLICATION SUB DATE
CUPERTINO DENTAL GROUP 303 OVERLOOK DR 05/06/2002
PHONE: SANITARYNO. CONTROL NO.
(831)338-2684
z ARCHITEC (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a
i LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby aRrm that l am licensed under pro inions of Chapter 9(commencing
w iN Sao, 70)0) n cion 3 Ofrhe Businesse Professions Code, and my license TENANT IMPROVEMENT
is in rce an t.
Lie Lim.
Date 'C
ContVAION
fn ARCHITECT'S D
�undersund my plansshall be used a ''
1•� iii
OLicensed Pmfusional
OWNER -BUILDER GLARATI
j�gW1'yA
H 1 hcmby affirm that 1 am exempt f 's L' for the
following reason. '•' aa�t.
(Semon ]031.5. Business CWe: r county
O which requires a permit to construct, or $60000
alter, improve, demolish, repair any stmcmrc ED
m ..prior m iu issuance, oho requires Ne applicant for sucb permit m file a sigsmd suumem
- sharhgislittnIt" ytvsWin"a ptwiuonsoftneConuacwlsLicenseLaw (Chspa" 9 Valuation
(commenGin;•iN A7 Of Division Sof the Businca and Profeaaions Code) +,",�'f�'i•317i?VVi
or thin rte is exempt thercfmm'ond The eters for the Wlcgbf,u'xemptiop. Any violation I
- of Seninm7031:5 by any npplicatn far o permit subjects the applicant to a civil penalty
of nut mina than. five hundred dollars(S5001. t`�""' Occupancy Type
101AP-NV ATION
❑ I, as owner of the property, or my employees with wages as their able compensation, _
-wilt do the work, sand -the structure is not Intended Of'Offered '(Or sale (See 704,1 " - - -
Business end Professions Code: The Contractor's License Law does not apply to an 103 - UFER Required Inspections' ^' '•-
owner of property Who builds or improves thereon, and who does such work himself
o through his own e pI y p idcd ibat i h improv m f not intended or 104 - RE BAR
-:'offercdfor le aimprovementu ld nne of " — •'' "-'
tl<ll he 105 ANCHOR BOLTS
owner of
completion, the weer -builder libuildinger W he
-ld have the Nen did not buil)
will pronng thin build or
improve for "oppose of.nm.). 106 - SEWER & WATER ' -.....
- _-----e ...---- ---- -- - - .._.. _._-._ .._ ....--.._. ---- „-.----
202--=
'71; as owner of the pmpeny.am exclusively contracting with licenud conuacton tO UNDERFLOOR PLUMBING : f.i'i �''ti'�I ti-••..
construct the project (Se<. 7044, Business and Professions Cad,:) The Contractors •.. .'
'- L' 1 d s not apply t an owner of property who b ' d improves thereon 203 - UNDERFLOOR MECHANICAL' �' `'
..and ho <o , acts.f r such projects with.a commctions) licensed.purs ant In me' - _, ..,. .
__2.04. — UNDERFLOOR-
C C f t L ccnab la - - „
1 t ode See- '' B&PCfor this Maabn 205 - UNDERFLOOR''"INSULATION
ro,=r $ O'Z- 301 - ROUGH PLUMBING
' WORKE COM ATIONDECLARATION
302 - TUB & OR SHOWER
he nr Miiarydnenfthefnnnwingdoelmamns: 303 - ROUGH MECHANICAL
❑ 1 have rural wdl'mainiam'a Cenifictte'of consem'm self -insure for worker's 3 04 - ROUGH ELECTRICAL
- Compensation,- u provided for by -Section 3700' of the Labor Code, for the
_ NrOnamee of foe work far which this Pgrmiti,issued . 305 — FRAME
❑Ihaveund'will martian Workers Compensations Insurance, as required by Section 306 - HOLDOWNS
3]IXI of the tabor Cad for The, Porro once (the work far which this Penna is -
issuedMy W fkei s Compcnsafion 1 r c and P l cy r rube m 307 INSULATION
_. _..r_..__
:.__...-•_._--_-._......�.•`-�
,:amer•3 ..� 308"=':SHEETROCK"....
Poj<
CERTIFICIAIROMWORK`�
sIATIONO El Ens d'i!i309�"-'�BRTERIOR%'tLATHi
'_ A TIO rt i
Q •._, • . • -3-10-, --" , • i---------------... - .... -....... ..
..•,-1N
SURANCBfnr
1' TERI OR""liATH •"
hunduJ-.
' T
(Tone seatlun need nut be'<um p lean if me a f one done
isiBB)uness.j '' 311 - SCRATCH COAT
, I dent Nei fn performance f rk f which th fs i s W I " -3.1 --- -ROOF NAIL--
„ y th i pertti t x
'shallnotemploy nyp n on m- sqy rmtheW kers 501 - FINAL EI;BCTRI' `'•ENERGY
nsxtgry Laws fC hf m' D
ant P%.g P��— 502.._ -..FINAL . PLUMBING ENERGY_.-- -- -
ICE AP L T If,
ANT: afmrmallsuglhnCemficmeofExemption: you should -
>- become iubPmtmthe Workers Compensation provisions of the Labor Code, you must 503 FINAL MECHANICAL"•'ENERGY
roanwimdomplywNrucnpmvisionaonhlsPermit xhWlbcdeemedmvuked.
j _ _ 504, FINAL BUILDING__..__.._____
CONSTRUCTION IENDINGAOENCY '., 505 - FINAL ELECTRICAL
I he by tftmt that there construction lending agency f the po formance 1
., bfth work f hich the picmt issued (Sac.309] Civ CI SO6 - GAS TEST ._.. .._. .__._..__
...Led Nnme '---- ._. .-.. .._.� _ _�. ..........
L ddrsAMlmssn 507 - FINAL PLUMBING,
> I certify that (pave rood this application end sum thin the above information is 508 - FINAL MECHANICAIli`
'coven. 1 agree with all ordinances sum laws relating'
nand 509 - FINAL GRADE
m racomply countywm
building conumaion :ted hereby hunk ri ze reprtsenmtives sof this city m enter upon
the sporla SIO — FINAL PLANNING
aboeWmentim16sve ardluoifymdionpuryoses.-
L (Wejsgreemmve, the idCa e
6
andepennd
G ks in 514 - FINAL UB C WORKS
cosh which wayacrusaid
end hihamay in any way accrue against said
may, against
inifmato
City
City canuqucnce of
in nerre of the of thispermit.
mg the
mg
y'AmpICANT UNDERSTAN" A WILL COMPLY WITH NON POINT'
'SOIIRCEREGULATIONS;'';"I''I'^l•'' i •. Issued by: Date
Sg t ApplicanUContnmm- '."'�. (Dam Re -roofs
• - -
: HAZARDOUS MATERIALS DISCLOSUR
!. worn appbcant 6 occupant tore or handle hazaNau�ftmrenal ,.Type Of Roof_ _.. ._.._._�.__......, .. _-.. ...
. m d f ed by N Cppcmnod Chepmr 9 12 a d the Health rW Sefery
Cade S t n255711e) e
° ^
,❑Yu
orBldrr"2
.All
roofs shallbeirispectedprlor.to any
roofing•materialbeinginstalled,•„th
occupant nne equpment Or device, whichIf a roof is installed'without first obtaining an'inspection,4agree to.remove
AutharnNous.1 camamby the Bay Arca Air O Wiry Management
Distnct all new materials for in_spechon _ Applican_ t understands and will comply, with _
0yes �N all non=point source [egulanons..
t
I have read the h rami ti msoroxis neutron a under Chapter 695 of the
Caldomiu Health &Surety Cade; Sections 25505:25533 and 25534; hundemand that .. _. ..__. ... _.. ....__._.. .. ..... _. - _..._
•if,ihe ng does not currently haveamnanr. thin it is my responsibility to notify the "" - '
;occupant of '
rhe it the requirements which'ntust he met prior hiissuance of,. Certs&am of
OR
Oil
r
- - -OFFICE' - - --
1. De,•.: wti. �r